Medical Policies

Medical Policy Update September 8, 2020

Medical Guidelines Reason for Update
Abdominoplasty, Panniculectomy and Lipectomy Specialty Matched Consultant Advisory Panel review 8/19/2020. No change to policy statement.
Amniotic Membrane and Amniotic Fluid Injections for Ophthalmic Indications Policy name updated from Amniotic Membrane and Amniotic Fluid Injections to Amniotic Membrane and Amniotic Fluid Injections for Ophthalmic Indications. Removed amniotic products related to burn and wound treatment from policy, Removed statement from "When covered" and "When not covered" sections related to rare skin conditions. Coding and Policy guidelines sections updated. Specialty Matched Consultant Advisory Panel review 8/19/2020.
BRCA AHS - M2003 Specialty Matched Consultant Advisory Panel review 8/19/2020. No changes to policy statement.
Breast Surgeries Removed reference to related archived policy. Specialty Matched Consultant Advisory Panel review 8/19/2020. No change to policy statement.
Colorectal Cancer Screening AHS-B0001 Specialty Matched Consultant Advisory Panel review 8/19/2020. No changes to policy statement.
Composite Allotransplantation of the Hand and Face Specialty Matched Consultant Advisory Panel 8/19/2020. References updated. No change to policy statement.
Cosmetic and Reconstructive Surgery Specialty Matched Consultant Advisory Panel 8/19/20. References updated. No change to policy statement.
Co-Surgeon, Assistant Surgeon, Team Surgeon and Assistant-at-Surgery Guidelines Updated ClaimCheck® to ClaimsXten™ in the Policy section. No change to policy statement.
CT Perfusion Imaging of the Brain Medical Director review 8/20/2020, policy archived.
Extracorporeal Photopheresis Specialty Matched Consultant Advisory Panel review 8/19/2020. Reference added. No changes to policy statement.
Familial Adenomatous Polyposis and MUTYH-Associated Polyposis AHS-M2024 Specialty Matched Consultant Advisory Panel review 8/19/2020. No changes to policy statement.
Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management AHS - M2166 Specialty Matched Consultant Advisory Panel review 8/19/2020. No changes to policy statement.
Immunoglobulin Therapy Under "When Covered" section, added the following indications: ALL and other B-cell lymphoproliferative disorders. Other minor edits made throughout policy for clarity. References added. Medical director review 8/2020.
Laser Treatment of Port Wine Stains Specialty Matched Consultant Advisory Panel review 8/19/2020. Coding and References updated. No change to policy statement.
Lynch Syndrome AHS-M2004 Specialty Matched Consultant Advisory Panel review 8/19/2020. No changes to policy statement.
Molecular Markers in Fine Needle Aspirates of the Thyroid AHS - M2108 Specialty Matched Consultant Advisory Panel review 8/19/2020. No changes to policy statement.
Molecular Panel Testing of Cancers for Diagnosis, Prognosis, and Identification of Targeted Therapy AHS - M2109 Specialty Matched Consultant Advisory Panel review 8/19/2020. No changes to policy statement.
Molecular Profiling for Cancers of Unknown Primary Origin AHS- M2065 Specialty Matched Consultant Advisory Panel review 8/19/2020. No changes to policy statement.
Prostate Cancer Screening AHS - G2008 Specialty Matched Consultant Advisory Panel review 8/19/2020. No changes to policy statement.
Reconstructive Eyelid Surgery and Brow Lift Specialty Matched Consultant Advisory Panel review 8/19/2020. References updated. No change to policy statement.
Rhinoplasty Specialty Matched Consultant Advisory Panel review 8/19/2020. Aging added to causes of internal nasal valve obstruction. Wegener's granulomatosis changed to granulomatosis with polyangiitis (GPA). Code 30465 added to Billing/Coding section.
Septoplasty Specialty Matched Consultant Advisory Panel review 8/19/2020. "Septoplasty may also be referred to as a submucousal resection of the septum and may be performed for reasons other than to correct a breathing impairment" removed from Description section. Policy Guidelines revised to read "Clinical nasal examination should include anterior rhinoscopy, or endoscopy if clinically indicated..."
Serum Tumor Markers for Malignancies AHS - G2124 Specialty Matched Consultant Advisory Panel review 8/19/2020. No changes to policy statement.
Skin and Soft Tissue Substitutes Policy name changed from Bioengineered Skin and Tissue to Skin and Soft Tissue Substitutes. Description, Policy guidelines, Coding and References sections updated. "When not covered" section reworded for clarity with "Skin and soft tissue substitutes are not covered when application site is infected or member has an allergy to the product." added. Added amniotic membrane products into policy for wound and burn applications. Clarified this policy does not apply to amniotic ophthalmic indications. "When covered" section completely reworded for clarity. Updated list of products considered always investigational.
Sleep Apnea: Diagnosis and Medical Management Reference added. Specialty Matched Consultant Advisory Panel review 8/19/2020.
Surgical Treatment of Chest Wall Deformities (Congenital or Acquired) Specialty Matched Consultant Advisory Panel 8/19/2020. References updated. No change to policy statement.
Testing for 5-Fluorouracil Use in Cancer Patients AHS-M2067 Specialty Matched Consultant Advisory Panel review 8/19/2020. No changes to policy statement.
Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders Clarification added to define the terms extension of initial therapy and maintenance to Policy Guidelines section. References added. Specialty Matched Consultant Advisory Panel review 6/17/2020. Medical Director review. No change to policy statement.
Tumor Tissue Mutation Analysis in Colorectal Cancer AHS - M2026 Specialty Matched Consultant Advisory Panel review 8/19/2020. No changes to policy statement.